Izawa H, Takeda J, Fukushima K
Department of Anesthesiology, School of Medicine, Keio University, Tokyo.
Masui. 1997 Feb;46(2):177-83.
To evaluate residual effects of inhalational anesthetics after reversal of neuromuscular blocking agent, neuromuscular function was monitored after halothane or sevoflurane anesthesia in thirty-seven patients (ASA physical status I or II) for elective surgery after obtaining informed consent. Electromyograph of the adductor pollicis muscle in response to train of four (TOF) stimulation was monitored throughout the study. The first twitch of TOF (T1; % of its control) and the ratio of the fourth twitch to the first twitch of TOF (T4/T1; TR) were recorded at 0, 2, 5, 10, and 15 min after reversal. The patients were divided into five groups; 1) the fentanyl group (n = 7) received fentanyl/N2O; 2) in the halothane stop group (n = 6), halothane was discontinued at least fifteen minutes before neostigmine administration; 3) in the halothane stable group (n = 7), 0.7% halothane was maintained until fifteen minutes after neostigmine; 4) in the sevoflurane stop group (n = 12), sevoflurane was discontinued fifteen minutes before the reversal; 5) in the sevoflurane stable group (n = 5), 3% sevoflurane was maintained until fifteen minutes after the reversal. Anesthesia was induced by thiopental 4 mg.kg-1 and suxamethonium 1 mg.kg-1 and the patients were intubated. After initial dose of vecuronium 0.1 mg.kg-1, the additional dose of 0.02 mg.kg-1 was administered to maintain T1 under 10% of the control value. At the end of the surgery atropine 0.015 mg.kg-1 and neostigmine 0.04 mg.kg-1 were administered to reverse vecuronium when T1 had recovered to 25% of its control. Halothane groups did not differ from fentanyl group. Recovery of T1 at 15 min was suppressed after discontinuation of sevoflurane (86.0 +/- 8.2%) in comparison with fentanyl (97.0 +/- 8.3%). Both T1 (75.4 +/- 12.2%) and TR (68.0 +/- 12.6%) at 15 min after the reversal during 3% sevoflurane inhalation were below those of the stable group. We conclude that the residual sevofulrane after discontinuation of inhalation may impair the neuromuscular transmission after the reversal of neuromuscular blockade. Neuromuscular function should be monitored after the end of anesthesia even though the patient is fully awake.
为评估神经肌肉阻滞剂逆转后吸入性麻醉剂的残余效应，在37例（ASA身体状况I或II级）择期手术患者获得知情同意后，于氟烷或七氟醚麻醉后监测神经肌肉功能。在整个研究过程中，监测拇内收肌对四个成串刺激（TOF）的肌电图反应。在逆转后0、2、5、10和15分钟记录TOF的第一个颤搐（T1；其对照值的百分比）以及TOF的第四个颤搐与第一个颤搐的比值（T4/T1；TR）。患者分为五组：1）芬太尼组（n = 7）接受芬太尼/N₂O；2）在氟烷停用组（n = 6），在新斯的明给药前至少15分钟停用氟烷；3）在氟烷稳定组（n = 7），维持0.7%氟烷直至新斯的明给药后15分钟；4）在七氟醚停用组（n = 12），在逆转前15分钟停用七氟醚；5）在七氟醚稳定组（n = 5），维持3%七氟醚直至逆转后15分钟。用硫喷妥钠4mg·kg⁻¹和琥珀胆碱1mg·kg⁻¹诱导麻醉并进行气管插管。给予初始剂量的维库溴铵0.1mg·kg⁻¹后，追加剂量0.02mg·kg⁻¹以维持T1低于对照值的10%。手术结束时，当T1恢复至对照值的25%时，给予阿托品0.015mg·kg⁻¹和新斯的明0.04mg·kg⁻¹以逆转维库溴铵作用。氟烷组与芬太尼组无差异。与芬太尼组（97.0±8.3%）相比，停用七氟醚后15分钟T1的恢复受到抑制（86.0±8.2%）。吸入3%七氟醚期间逆转后15分钟的T1（75.4±12.2%）和TR（68.0±12.6%）均低于稳定组。我们得出结论，吸入停止后七氟醚的残余效应可能会损害神经肌肉阻滞剂逆转后的神经肌肉传递。即使患者已完全清醒，麻醉结束后也应监测神经肌肉功能。
